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21 hours ago, BrianOCD said:

I've heard this too from others...I also feel just blank minded, is that a part of depression and coming out of it?Β  I feel like I can treat the depression and anxiety, but there's not much left there with my fried brain....

Yeah I would describe it as a bit blank minded, which was nice at the time because my negative thoughts were cycling at me downward really hard. I think it cleared space in my brain. When I mentioned in the past to my pdoc that this space-cadet effect bothered me, he said its a sign that the med was working and I "seemed" better, like it was lifting me out...

Maybe it feels blank when you are coming from an emotional place? Do you feel blah, numb or anhedonic? Or do you feel you need some sort of cognitive boost (those reasons were why my pdoc added a stimulant to my previous cocktail)

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4 hours ago, Blahblah said:

Yeah I would describe it as a bit blank minded, which was nice at the time because my negative thoughts were cycling at me downward really hard. I think it cleared space in my brain. When I mentioned in the past to my pdoc that this space-cadet effect bothered me, he said its a sign that the med was working and I "seemed" better, like it was lifting me out...

Maybe it feels blank when you are coming from an emotional place? Do you feel blah, numb or anhedonic? Or do you feel you need some sort of cognitive boost (those reasons were why my pdoc added a stimulant to my previous cocktail)

I don't know it's just emptiness, like there's a void all the time, when Effexor worked before I felt like a million bucks and felt fine.Β  I hope it does that again.

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Hey @BrianOCDΒ  I was wondering if you're feeling any better? Are you still on 300mg Effexor? I've just started up on it again as I was in a very bad way the last couple months. I noticed effect at 37.5mg the first day...extremely apathetic, lethargic, out of it, and spacey. But this time it's worrying me as I've got work I need to complete and things to do. I was productive & doing well on just Lamictal & Ritalin, and then it stopped covering my symptoms.

I hope the Effexor works better at higher dose. I will go up to at least 150mg. Is this the point where norepinephrine or dopamine kicks in? Anyway, I hope things are going better for you.

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You've probably answered this a million times, @Blahblah, but have you ever tried going up on the Lamictal? 200 mg is typically the dose used for bipolar and mood disorders, but I was on 400 mg at one point because it crapped out on me. I did have a bit of cognitive blunting, and the acne was horrendous, but it was helping. Eventually I discovered Zonegran. Then I got off Lamictal.

As for your Effexor, you could be a poor metabolizer or intermediate metabolizer of CYP2D6, thereby decreasing the level of the active metabolite O-desmethylvenlafaxine (AKA desvenlafaxine (Pristiq)) and increasing venlafaxine levels, which would increase side effects rather than give benefits. Pristiq was made to circumvent this, so maybe it would be worth a shot. Also, there's Fetzima and Savella (I don't know if those are available where you live). I think the Savella (as it's called in the US), or milnacipran, may be available where you live.

Also, there are different formulations of Ritalin... Ritalin SR, Ritalin LA, Metadate CD, Concerta, Daytrana, Aptensio XR, Cotempla XR-ODT, Metadate ER, Methylin, Quillichew ER, Quillivant XR, etc., probably more or others where you live. There are also the amphetamines, which are more potent than Ritalin. Dextroamphetamine or even Vyvanse may help better than Ritalin... but it seems you've tried amphetamines before.

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8 hours ago, mikl_pls said:

You've probably answered this a million times, @Blahblah, but have you ever tried going up on the Lamictal? 200 mg is typically the dose used for bipolar and mood disorders, but I was on 400 mg at one point because it crapped out on me. I did have a bit of cognitive blunting, and the acne was horrendous, but it was helping. Eventually I discovered Zonegran. Then I got off Lamictal.

As for your Effexor, you could be a poor metabolizer or intermediate metabolizer of CYP2D6, thereby decreasing the level of the active metabolite O-desmethylvenlafaxine (AKA desvenlafaxine (Pristiq)) and increasing venlafaxine levels, which would increase side effects rather than give benefits. Pristiq was made to circumvent this, so maybe it would be worth a shot. Also, there's Fetzima and Savella (I don't know if those are available where you live). I think the Savella (as it's called in the US), or milnacipran, may be available where you live.

Also, there are different formulations of Ritalin... Ritalin SR, Ritalin LA, Metadate CD, Concerta, Daytrana, Aptensio XR, Cotempla XR-ODT, Metadate ER, Methylin, Quillichew ER, Quillivant XR, etc., probably more or others where you live. There are also the amphetamines, which are more potent than Ritalin. Dextroamphetamine or even Vyvanse may help better than Ritalin... but it seems you've tried amphetamines before.

@mikl_pls no worries. I always appreciate your perspective. My pdoc just upped Lamictal to 150mg (as 100mg is indeed a sub dose) Long ago, I had taken up to 400mg but had major cognition problems, word finding, and balance issues. Hopefully 150mg-200mg will hit the sweet spot. I like that it's subtle stabilizer, not too heavy duty. I'm sensitive to side effects.

As for Effexor, I'm having mixed feelings. Only day 4..start-up effects but just hate this icky feeling. When I wake up in mornings (perhaps it's worn off) but I feel anxious and hot flashes/sweaty, which is also not normal for me. Then I feel zoned, apathetic, lethargic all day. I have real difficulty getting any other stimulant other than methylphenidate, pdocs never want to prescribe it in my experiences.

I guess all i can do is wait? I get unstable making frequent switches, so I may just try upping Ritalin a bit to push past this apathy. I'll make note of your suggestions if this doesn't work, but I am always told to give like 4-6 weeks, meh.

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11 hours ago, Blahblah said:

@mikl_pls no worries. I always appreciate your perspective. My pdoc just upped Lamictal to 150mg (as 100mg is indeed a sub dose) Long ago, I had taken up to 400mg but had major cognition problems, word finding, and balance issues. Hopefully 150mg-200mg will hit the sweet spot. I like that it's subtle stabilizer, not too heavy duty. I'm sensitive to side effects.

As for Effexor, I'm having mixed feelings. Only day 4..start-up effects but just hate this icky feeling. When I wake up in mornings (perhaps it's worn off) but I feel anxious and hot flashes/sweaty, which is also not normal for me. Then I feel zoned, apathetic, lethargic all day. I have real difficulty getting any other stimulant other than methylphenidate, pdocs never want to prescribe it in my experiences.

I guess all i can do is wait? I get unstable making frequent switches, so I may just try upping Ritalin a bit to push past this apathy. I'll make note of your suggestions if this doesn't work, but I am always told to give like 4-6 weeks, meh.

Ah, so you've been up there too? Yeah, I couldn't tolerate it for long, and the acne it was causing me was horrendous.

Effexor gives meΒ THE WORSTΒ sexual side effects and constipation right next to clomipramine (Anafranil) minus the urinary retention that Anafranil caused me. Effexor is a medicine with a very short half-life and requires that you take it the same time every day and NOT forget it! lol. I'm lucky insofar as I didn't get withdrawal side effects too badly when I went off of it, but some people get withdrawal effects if they wait 30 minutes past when they took it last. That's why I was suggesting Pristiq as a possible alternative. People tend not to get withdrawal effects with it.

Yeah, stimulants have such a stigma unfortunately such that doctors deny treatment for someone who may desperately need them. If sticking with methylphenidate is what your pdoc wants to do, s/he could at least give you more than 20 mg. That's a baby dose for an adult.

I hope you find the relief that you deserve!

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On 5/9/2019 at 2:46 AM, Blahblah said:

Hey @BrianOCDΒ  I was wondering if you're feeling any better? Are you still on 300mg Effexor? I've just started up on it again as I was in a very bad way the last couple months. I noticed effect at 37.5mg the first day...extremely apathetic, lethargic, out of it, and spacey. But this time it's worrying me as I've got work I need to complete and things to do. I was productive & doing well on just Lamictal & Ritalin, and then it stopped covering my symptoms.

I hope the Effexor works better at higher dose. I will go up to at least 150mg. Is this the point where norepinephrine or dopamine kicks in? Anyway, I hope things are going better for you.

Meh not really, but I'm taking a generic version, it doesn't seem to pack the same punch as the brand.

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On 5/9/2019 at 2:46 AM, Blahblah said:

I hope the Effexor works bο»Ώetter at higher dose. I will go up to at least 150mg. Is this the point where norepinephrine or dopamine kicks in?

~150 mg is where it truly becomes an SNRI.

~300-375Β mg is where it becomes an SNDRI forΒ someΒ people, and works very weakly if at all on dopamine. You'd be better off taking something with stronger DRI like methylphenidate or dexmethylphenidate (Ritalin or Focalin). Even bupropion (Wellbutrin) or sertraline (Zoloft) would suffice.

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Related question: Has anyone taken Effexor at night? I've always taken all meds in the morning, but as the start-up is making me so lethargic, I wonder if taking at night would help? Then at higher doses, I could switch to morning? Is that a weird/bad idea?

@mikl_pls I probably need to up Ritalin dose, or switch to Focalin. I've been on 20mg (which I hear is a "baby dose" ) for over a year and it's really not cutting it. I get maybe a few hours of noticeable boost and then my mood starts going downhill by the afternoon. I've been conservative. I don't want to have to start popping them like candy, and keep raising the dose (plus i'm only 47kg)

Unfortunately, I trialed Wellbutrin twice in past, did absolutely nothing but give me Tinnitus. Zoloft made me psychotic/paranoid years ago, so hesitant to go there again.

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8 hours ago, Blahblah said:

Related question: Has anyone taken Effexor at night? I've always taken all meds in the morning, but as the start-up is making me so lethargic, I wonder if taking at night would help? Then at higher doses, I could switch to morning? Is that a weird/bad idea?

The only problem I could foresee with this is the withdrawal effects you get when you don't take Effexor at the same time every day. But some people don't get those.

8 hours ago, Blahblah said:

@mikl_pls I probably need to up Ritalin dose, or switch to Focalin. I've been on 20mg (which I hear is a "baby dose" ) for over a year and it's really not cutting it. I get maybe a few hours of noticeable boost and then my mood starts going downhill by the afternoon. I've been conservative. I don't want to have to start popping them like candy, and keep raising the dose (plus i'm only 47kg)

My goodness. I don't know your height, but 47 kg is a bit thin. Ritalin/Focalin for most people doesn't cause as much weight loss as amphetamines do. Sometimes it's the other way around for some reason (even though the mechanisms of action theoretically should be that it is the former). If you're conservative, going to Ritalin 30 mg/day or Focalin 10-15 mg/day would be the best way to go in my unprofessional opinion. Going to 40 mg Ritalin or 15-20 mg Focalin would be if you really wanted to get a noticeable effect. That would be between you and your pdoc. If you don't want to lose any more weight, I would probably stay away from the amphetamines, especially dextroamphetamine or Vyvanse.

9 hours ago, Blahblah said:

Unfortunately, I trialed Wellbutrin twice in past, did absolutely nothing but give me Tinnitus. Zoloft made me psychotic/paranoid years ago, so hesitant to go there again.

Ah, I'm sorry you had to go through that. :(Β You may want to be very careful with raising your stimulant dose then, simply because there's no way of knowing whether it was the increased serotonin or dopamine that caused you to go into psychosis with Zoloft (which is a SDRI). Increased dopamine is the classical mechanism of action behind psychosis, but other neurotransmitters play into it, and other neurotransmitters interact with other neurotransmitters by means of autoreceptors and heteroreceptors.

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@mikl_pls yeah, I'm usually around 50-52kg, which is thin end of normal on the chart, been same weight for 20 years. But when I'm stressed and on ritalin I lose a bit. Plus I've lost a lot of muscle, due to not exercising. The only thing I can think of with the Zoloft is maybe because it was the first med I ever took as a teen, so I was ultra-sensitive to it?

I've upped the Ritalin to 30mg and I feel sort of tired. Is this normal? I'm focused, but not motivated to focus on what I need to be focusing on. It's strange how stimulants work. Variable & unpredictable, but I suppose it depends on what you eat with it in the morning, I took vitamins and usually have coffee with it.

Β 

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On 5/12/2019 at 3:48 PM, Blahblah said:

Related question: Has anyone taken Effexor at night? I've always taken all meds in the morning, but as the start-up is making me so lethargic, I wonder if taking at night would help? Then at higher doses, I could switch to morning? Is that a weird/bad idea?

@mikl_pls I probably need to up Ritalin dose, or switch to Focalin. I've been on 20mg (which I hear is a "baby dose" ) for over a year and it's really not cutting it. I get maybe a few hours of noticeable boost and then my mood starts going downhill by the afternoon. I've been conservative. I don't want to have to start popping them like candy, and keep raising the dose (plus i'm only 47kg)

Unfortunately, I trialed Wellbutrin twice in past, did absolutely nothing but give me Tinnitus. Zoloft made me psychotic/paranoid years ago, so hesitant to go there again.

Not a weird idea, I've tried it before, but Effexor is odd in that it can be stimulating at times too.Β  I decided to keep it in the morning.

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@BrianOCD I actually took it late last night before bed. I slept fine. Just an upset stomach this morning.Β  I just have a feeling by the time I get up above 75mg though, it will be stimulating and I'll need to switch back to morning. Do you think so?Β  How long have you been on the 300mg? are you feeling any better/or the same?

It's still spacing me out, I feel fuzzy, and I seem to be having the same effect you mentioned: the feeling "stuck" when I go to do things. Like getting out of bed for example, getting dressed. Like I'm overthinking everything, which normally, many things I just "do them" without the resistance, its strange. Like I'm in slow motion.

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9 hours ago, Blahblah said:

@BrianOCD I actually took it late last night before bed. I slept fine. Just an upset stomach this morning.Β  I just have a feeling by the time I get up above 75mg though, it will be stimulating and I'll need to switch back to morning. Do you think so?Β  How long have you been on the 300mg? are you feeling any better/or the same?

It's still spacing me out, I feel fuzzy, and I seem to be having the same effect you mentioned: the feeling "stuck" when I go to do things. Like getting out of bed for example, getting dressed. Like I'm overthinking everything, which normally, many things I just "do them" without the resistance, its strange. Like I'm in slow motion.

I've been on as much as 825 mg before... it stopped working for me. At 375-450 mg though it was rather stimulating, but very short-lived. Profound tachyphylaxis.

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Posted (edited)
15 hours ago, Blahblah said:

@BrianOCD I actually took it late last night before bed. I slept fine. Just an upset stomach this morning.Β  I just have a feeling by the time I get up above 75mg though, it will be stimulating and I'll need to switch back to morning. Do you think so?Β  How long have you been on the 300mg? are you feeling any better/or the same?

It's still spacing me out, I feel fuzzy, and I seem to be having the same effect you mentioned: the feeling "stuck" when I go to do things. Like getting out of bed for example, getting dressed. Like I'm overthinking everything, which normally, many things I just "do them" without the resistance, its strange. Like I'm in slow motion.

Unfortunately this generic version of Effexor isn't working for me.Β  The Brand Effexor did wonders for me though.Β Β  I'm at 300mg and I'm still depressed. Β  Going on 18 months now...It has worked for shutting down a lot of unnecessary chatter though.

I think that stuck, confused feeling is a part of the depression/anxiety.Β  Another crappy part of it.

This is my 4th severe depression and it's truly awful, I'd honestly rather have a year of cancer with no MI, than rot away like this.

Edited by BrianOCD

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